Esther Meesterberends

International prevalence measurement of care problems: results.

AIM This report describes the results from the last international prevalence measurement of care problems in the Netherlands, Austria and Switzerland, including the course of the prevalence rates during the past 4 years. BACKGROUND Basic care problems such as pressure ulcers, malnutrition and falls occur frequently in healthcare organizations. Measuring these care problems provides insight into their occurrence, and, while a measurement is included of the prevention, treatment and structural quality indicators, this gives institutions the possibility of improving their care regarding these care problems. DESIGN An annual cross-sectional multicentre study. METHOD The prevalence measurement of care problems is conducted annually on one specific day in different healthcare settings, among which are hospitals and care homes. Data are collected by means of a comprehensive, standardized questionnaire that comprises three levels: institutional, ward/department and patient level. RESULTS Besides general characteristics of patients, results are presented for prevalence rates, prevention, treatment and quality indicators regarding each care problem for each country.

An International prevalence measurement of care problems: study protocol

AIM The aim of this article was to describe the design of an international audit of the prevalence of care problems in different healthcare sectors using identical methodologies. BACKGROUND Audits, defined as a monitor of quality of health care, are increasingly applied in many countries as a strategy to improve professional practice and quality and safety of care. A prerequisite to enable a reliable comparison of quality of care audits is the use of identical instruments and methodology. DESIGN Annual cross-sectional multi-centre point prevalence survey. METHOD This international prevalence measurement of care problems in hospitals, care homes and home care is performed in the Netherlands, Austria, Switzerland and New Zealand. This study is based on a prevalence measurement of care problems originally performed in the Netherlands. For each care problem (pressure ulcer, incontinence, malnutrition, falls and restraints) at patient level, next to patient characteristics, data are gathered about the prevalence, prevention and treatment of each care problem. In addition, at ward/department and institution level, specific quality indicators are measured related to the care problems. After the measurement, institutions enter their data into a web-based data-entry program. Institutions receive an overview of their own results and results at national level to enable a process of benchmarking. DISCUSSION A uniform way of measuring the prevalence of care problems internationally is a significant step forward in gaining insight into the quality of basic care in different healthcare settings in different countries and may lead to more awareness and improvement programmes.

Pressure ulcer guideline development and dissemination in Europe

AIMS AND OBJECTIVES To explore the current state of pressure ulcer guideline development and dissemination, from national to local level (i.e. nursing homes) in six European countries: England, Germany, Italy, the Netherlands, Portugal and Sweden. BACKGROUND Pressure ulcers are a persistent problem in healthcare institutions. Their prevalence is influenced by many factors, one of them being the development and dissemination of pressure ulcer guidelines. These are difficult and complex processes and it is not clear whether they differ between European countries. DESIGN Literature review and semi-structured interviews. METHOD Interviews were conducted in six countries at national and nursing home level. RESULTS Four countries had national pressure ulcer prevention and treatment guidelines. Portugal had no national guidelines and Sweden had shifted the responsibility to regional level. All participating nursing homes had pressure ulcer guidelines except those in Portugal. Control and monitoring of guideline dissemination was carried out only in Sweden and England. CONCLUSIONS All countries studied have national or regional pressure ulcer prevention and treatment guidelines, except Portugal. Portugal is also the only country where none of the nursing homes included had pressure ulcer guidelines. Because the dissemination of such guidelines does not imply actual implementation, further research should focus on the implementation process. RELEVANCE TO CLINICAL PRACTICE Clinical guidelines, like pressure ulcer guidelines, are important tools in guiding the care processes in healthcare institutions. Successful dissemination of guidelines from national level to individual healthcare institutions is a first and necessary step in actually applying them. Monitoring of the guideline dissemination process is therefore essential.

Do Patients in Dutch Nursing Homes Have More Pressure Ulcers Than Patients in German Nursing Homes? A Prospective Multicenter Cohort Study

OBJECTIVES To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. DESIGN A prospective multicenter cohort study. SETTING Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). PARTICIPANTS A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. MEASUREMENTS Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. RESULTS A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. CONCLUSION The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls.

Pressure ulcer incidence in Dutch and German nursing homes: design of a prospective multicenter cohort study

BackgroundPressure ulcers are a common and serious health care problem in all health care settings. Results from annual national pressure ulcer prevalence surveys in the Netherlands and Germany reveal large differences in prevalence rates between both countries over the past ten years, especially in nursing homes. When examining differences in prevalence and incidence rates, it is important to take into account all factors associated with the development of pressure ulcers. Numerous studies have identified patient related factors, as well as nursing related interventions as risk factors for the development of pressure ulcers. Next to these more process oriented factors, also structural factors such as staffing levels and staff quality play a role in the development of pressure ulcers. This study has been designed to investigate the incidence of pressure ulcers in nursing homes in the Netherlands and Germany and to identify patient related factors, nursing related factors and structural factors associated with pressure ulcer development. The present article describes the protocol for this study.Methods/designA prospective multicenter study is designed in which a cohort of newly admitted nursing home residents in 10 Dutch and 11 German nursing homes will be followed for a period of 12 weeks. Data will be collected by research assistants using questionnaires on four different levels: resident, staff, ward, and nursing home.DiscussionThe results of the study will provide information on the incidence of pressure ulcers in Dutch and German nursing homes. Furthermore, information will be gathered on the influence of patient related factors, nursing related factors and structural factors on the incidence of pressure ulcers. The present article describes the study design and addresses the studys strengths and weaknesses.

Evaluation of the dissemination and implementation of pressure ulcer guidelines in Dutch nursing homes

RATIONALE, AIMS AND OBJECTIVES Annual national prevalence surveys have been conducted in the Netherlands over the past 10 years and have revealed high prevalence rates in Dutch nursing homes. Pressure ulcer guideline implementation is one of the factors that can influence prevalence rates. Previous research has shown that these guidelines are often only partly implemented in Dutch nursing homes. Reasons for this lack of pressure ulcer guideline implementation are not known. Therefore, the aim of this study is to investigate the current situation regarding pressure ulcer guideline dissemination and implementation in Dutch nursing homes. METHODS Semi-structured interviews were conducted in eight nursing homes in the Netherlands from January till December 2008. In each nursing home, interviews were held with eight persons. RESULTS The implementation of pressure ulcer guidelines was lacking in some of the nursing homes. Risk assessment scales were often not used in practice, repositioning schemes were not always available and, when they were, they were often not used in practice. Knowledge about guideline recommendations was also lacking and pressure ulcer education was inadequate. Barriers to applying guideline recommendations in practice were mostly related to personnel and communication. CONCLUSIONS The implementation of pressure ulcer guidelines does not seem to be successful in all nursing homes and needs more attention. Barriers mentioned by the interviewees in applying guideline recommendations need to be addressed. Providing adequate education for nursing home staff and increasing attention for pressure ulcer care can be the first steps in improving the implementation of pressure ulcer guidelines.

Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands

Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOCs conceptual framework.

Editorial: The meaning of being a guest editor — a real challenge!

Writing and publishing is a key activity for students undertaking their PhD and working on their scientific career. How to structure papers, the ‘do’s and don’ts’ of academic writing style, how to react to editorial and reviewer comments and how to re-submit papers are challenges PhD students have to master, probably for the first time in their life. In addition to the exiting nature of this endeavour, the Editor in Chief of the JCN Roger Watson provided a group of PhD students from the Netherlands, Austria and Germany insight into the ‘other side of the coin’: managing manuscripts from submission to the decision. Now, we were faced with questions like how to choose reviewers, how to deal with reviewer comments or how to decide on acceptance or rejection. Given that there is an art and science of writing and submitting manuscripts, we learned that there must also be a kind of editorial science that is hard work too. Before starting this experience, we got a short introduction to the editorial system of JCN. We were eager to learn, e.g. how to find appropriate reviewers and what would happen with their comments subsequently. Thus prepared, we looked forward to manage the editorial process quiet easily – somehow naı̈ve, as we can tell now at the end of the process. We were given the opportunity to prepare a special edition of the JNC containing papers by PhD students who presented their work during one of the European Doctoral Conferences in Nursing Science (EDCNS, http:// www.unimaas.nl/edcns/) in the last three years. EDCNS is a conference for doctoral students all over Europe organised by members of the PhD programme ‘Nursing Science’, which is a collaborative programme of Maastricht University (the Netherlands), the Charite-Universitätsmedizin Berlin (Germany) and the Medizinische Universität Graz (Austria). The conference provides the opportunity to meet and build contacts with colleagues all over Europe, to present a research project as part of a thesis, to share experiences and information in the area of nursing research and to learn what is currently happening in nursing science in Europe. First, we invited all participants of EDCNS from 2007, 2008 and 2009 to submit an abstract of their article. We received over 40 abstracts and about 30 authors were invited to submit an article. For selecting appropriate reviewers for the incoming drafts, the system offered a list of experts related to the respective topic. The keywords each author has to name during the submitting process guided us herein. Well, an easily manageable task we thought, but it turned out to be more complicated than we thought! As participants of the past EDCNS conferences presented a wide range of topics, we also received a wide range of topics for publishing in this special issue of JCN. Suddenly, and especially for some very special topics, the number of selectable reviewers was very small. Nevertheless, we had to find an appropriate solution: an expert in the field (methodological and with regard to content) willing to comment on the draft as a reviewer. In some cases, it took an astonishingly long time until we received an answer, and to our surprise, this was not always an acceptance. Thus, we had to learn new strategies in selecting an appropriate number of potential reviewers at the beginning to get the necessary persons willing to review the submission and resubmissions. Furthermore, we had to learn how to deal with helpful as well as less helpful and contradictory comments about the reviewed manuscript. In some cases, we received, e.g. the recommendation ‘minor revision’ from one reviewer and ‘reject and resubmit’ from the other reviewer. In these cases, we read thoroughly through the drafts, balanced the reviewers’ comments with our impression and made the decision how to proceed. The other side of our experiences was much more enjoyable. We received quite a wide range of interesting topics for publishing. Furthermore, it was a pleasure to see how the drafts mature based on reviewers’ comments. And now, at the end of a very interesting and informative way, we are able to present this special issue containing 18 articles in the area of nursing science. A substantial part of the included articles deal with the quality of care (Grondahl et al. and Zadelhof & Verbeek) nursing phenomena (Fossum et al., Johansson et al., Medin et al.) or the documentation of nursing diagnoses (Paans et al.) Three articles (Hahn et al., Nau et al. and Zeller et al.) concentrate on several aspects of patient’s and visitors’ aggression. Further articles focus on the implementation (Corchón Arreche et al.) and use of research results (Wangensteen et al.), respectively, and adherence to a guideline (Janssen et al.). The applicability of an educational tool and the validation of an instrument for assessing breastfeeding are dealt with by Golsäter et al., respectively, Zobbi et al. Being suddenly an informal caregiver (Pereira et al.) and nurses’ physical health profile (Fronteira et al.) complete the broad spectrum of very interesting topics.

Van meten naar implementeren

AbstractDeze rubriek biedt de ruimte voor de bespreking van belangrijke ontwikkelingen rond landelijke en lokale gezondheids- en zorgregistraties, waartoe ook gezondheidsenquêtes en epidemiologische surveys worden gerekend. Voor inlichtingen kunt u terecht bij Margreet Bloemers (bloemers@zonmw.nl) die deze rubriek beheert.ABSTRACTFrom measurement to implementation. Fifteen years prevalence measurements The Dutch national prevalence measurement of care problems (LPZ) was founded in 1998. It is an annual measurement of the prevalence, prevention, treatment and structure indicators of some relevant care problems in different health care sectors.In the LPZ all patients of the participating organizations are assessed by two caregivers at the same day. After the measurement each organization receives an overview of its results, together with the aggregated results of comparable organizations for benchmarking. The overall effect of the measurement is that during the years the prevalence of several care problems, such as pressure ulcers and malnutrition, has been reduced. So, the LPZ is not only a monitor of care problems, but stimulates also activities towards improvement of the quality of care. Nowadays, tools and examples of best practices are offered to the organizations to support them in improving their quality of care. Since a few years the LPZ is also conducted in other countries, incl. Austria, Switzerland and New Zealand. Using the same LPZ- instruments and methodology, provides unique possibilities to compare relevant aspects of care problems within and between countries.